Marquisa Wade

Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.

• Managed multiple priorities effectively, resulting in on-time completion of credentialing tasks for numerous providers simultaneously.
• Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
• Conducted primary source verifications such as background checks and board certifications.
• Expedited onboarding process for new providers, ensuring timely completion of all required documentation and verifications.
• Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
• Enhanced credentialing processes by streamlining documentation and verification procedures.
• Facilitated communication between departments, resulting in improved collaboration during credentialing process.
• Developed strong relationships with external organizations, leading to increased cooperation during verification processes.
• Received and evaluated applications to look for missing and inaccurate information.
• Achieved greater accuracy in database management by regularly updating provider records and tracking status changes.
• Demonstrated excellent problem-solving skills when confronted with complex issues or discrepancies during credentialing process.
• Maintained thorough understanding of accreditation standards, enabling accurate interpretation of guidelines for staff members when needed.
• Ensured compliance with industry standards by regularly updating policies and procedures related to credentialing.
• Assisted in training new employees on proper credentialing procedures, contributing to their rapid integration into team environment.
• Contributed positively to team dynamics by fostering a collaborative and supportive work environment.
• Liaised with healthcare providers to address and resolve any credentialing issues promptly, maintaining strong professional relationships, and high level of data integrity
• Managed credentialing files with strict adherence to confidentiality and privacy laws, ensuring secure handling of sensitive information.
• Reduced expenses by analyzing compensation policies and implementing competitive programs while ensuring adherence to legal requirements.
• Promoted a culture of continuous learning and development within the Grievance Appeals team, encouraging skill growth and knowledge sharing.
• Established strong relationships with internal and external stakeholders to facilitate smooth information exchange during case investigations.
• Conducted thorough investigations for complex cases, ensuring fair and accurate outcomes.
• Reduced case backlog significantly through diligent review and resolution of pending grievances.
• Enhanced grievance appeals efficiency by streamlining processes and implementing best practices.
• Demonstrated exceptional problem-solving skills when faced with unique or challenging cases, resulting in successful resolutions that satisfied all parties involved.
• Improved customer satisfaction rates by providing timely and empathetic responses to appeals inquiries.
• Contributed to higher client retention rates through exceptional service delivery during the grievance appeals process.
• Leveraged advanced analytical abilities when evaluating evidence presented in appeal cases, rendering unbiased judgments aligned with organizational policies.
• Displayed excellent time management skills while managing multiple high-priority cases concurrently without compromising quality or attention to detail.
• Acted as a departmental resource on appeals matters.

• Assisted in preparation of monthly financial reports by providing accurate A/R data for analysis and decision-making purposes.
• Maintained detailed records of all accounts receivable transactions, ensuring accuracy and completeness of financial data.
• Conducted periodic account reconciliations to identify potential errors or discrepancies in billing or payments received.
• Adapted quickly to changing business needs or priorities, demonstrating flexibility and commitment to continuous improvement in A/R operations.
• Developed strong relationships with key clients by fostering open lines of communication and ensuring prompt resolution of any concerns or disputes.
• Assisted with credit analysis for new clients, conducting thorough research and providing recommendations based on risk profiles and payment histories.
• Maintained organized filing system for all A/R documentation, facilitating easy retrieval for audits or other internal reviews as needed.
• Collaborated with sales, customer service, and accounting teams to ensure accurate invoicing and timely payments from clients.
• Provided excellent customer service when addressing client inquiries regarding billing issues or payment status updates.
• Participated in regular meetings with cross-functional teams focused on process improvement initiatives, representing A/R department and providing valuable insight into potential areas of enhancement.
• Managed high volume of invoices while maintaining strict attention to detail and adherence to established deadlines.
• Supported year-end financial audits by preparing necessary documentation and responding promptly to auditor inquiries related to accounts receivable.
• Reduced outstanding receivables by diligently following up on overdue invoices and negotiating payment terms with clients.
• Contributed to reduction in bad debt write-offs through proactive communication with delinquent accounts and negotiation of payment arrangements.
• Researched industry trends related to credit management strategies, recommending updates or enhancements as appropriate for continued improvement in A/R operations.

Same as previously described for Aya Healthcare

• Improved customer satisfaction by promptly addressing and resolving auto liability claims.
• Collaborated with law enforcement agencies as needed to gather information relevant to claim investigations.
• Built strong professional relationships with policyholders, fostering trust and loyalty to the company.
• Investigated losses and identified coverage issues.
• Conducted thorough investigations for accurate claim evaluations and fair settlements.
• Managed a high volume of claims simultaneously, maintaining organization and efficiency under pressure.
• Negotiated fair settlement amounts with claimants, ensuring timely case resolution.
• Supported company growth goals by consistently meeting or exceeding performance targets related to caseload management and customer satisfaction.
• Obtained and reviewed evidence, reports and medical records.
• Developed expertise in various insurance software systems for efficient data management and reporting purposes.
• Collaborated with legal teams to defend company interests in disputed claims cases.
• Participated in continuous improvement initiatives aimed at refining internal processes related to auto liability claims handling.
• Kept up-to-date on industry trends and legislation changes, ensuring knowledge-based decision making in daily tasks.
• Provided exceptional customer service during difficult circumstances, empathizing with clients while effectively addressing their concerns.
• Trained new team members on best practices for auto liability adjusting, enhancing overall department performance.
• Implemented cost-saving measures by identifying opportunities for subrogation or deductible recoveries when appropriate.